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In this Case Study in Physiology, we describe a patient with COVID\u201019 whose pulmonary gas exchange and oxygen delivery were severely compromised by COVID\u201019 pneumonia requiring extracorporeal membrane oxygenation (ECMO) support. His clinical course was complicated by a secondary superinfection with staphylococcus aureus and sepsis. This case study is provided with two goals in mind (1) We outline how basic physiology was used to address life\u2010threatening consequences of a novel infection\u2014COVID\u201019. (2) We describe a strategy of whole\u2010body cooling to lower the cardiac output and oxygen consumption, use of the shunt equation to optimize flow to the ECMO circuit, and transfusion to improve oxygen\u2010carrying capacity when ECMO alone failed to provide sufficient oxygenation.<\/jats:p>","DOI":"10.14814\/phy2.15602","type":"journal-article","created":{"date-parts":[[2023,2,18]],"date-time":"2023-02-18T01:37:34Z","timestamp":1676684254000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of two circulations in a <scp>COVID<\/scp>\u201019 patient with secondary superinfection"],"prefix":"10.14814","volume":"11","author":[{"given":"Rachael","family":"Stadlen","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care and Occupational Medicine University of Iowa  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arun K.","family":"Singhal","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery University of Iowa  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert M.","family":"Reed","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine University of Maryland  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey D.","family":"Hasday","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine University of Maryland  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2605-0984","authenticated-orcid":false,"given":"Melissa L.","family":"Bates","sequence":"additional","affiliation":[{"name":"Department of Health and Human Physiology University of Iowa  Iowa City Iowa USA"},{"name":"Department of Pediatrics University of Iowa  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5013-6323","authenticated-orcid":false,"given":"Gregory A.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Occupational Medicine University of Iowa  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6108-2546","authenticated-orcid":false,"given":"Michael","family":"Eberlein","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine University of Maryland  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_7_2_1","DOI":"10.1001\/jama.2019.9302"},{"doi-asserted-by":"publisher","key":"e_1_2_7_3_1","DOI":"10.1093\/bja\/43.12.1113"},{"doi-asserted-by":"publisher","key":"e_1_2_7_4_1","DOI":"10.1111\/aor.14090"},{"doi-asserted-by":"publisher","key":"e_1_2_7_5_1","DOI":"10.1164\/ajrccm.151.1.7812538"},{"doi-asserted-by":"publisher","key":"e_1_2_7_6_1","DOI":"10.1513\/AnnalsATS.201602\u2010107CC"},{"doi-asserted-by":"publisher","key":"e_1_2_7_7_1","DOI":"10.6061\/clinics\/2014(03)05"},{"doi-asserted-by":"publisher","key":"e_1_2_7_8_1","DOI":"10.1183\/09031936.00037014"},{"doi-asserted-by":"publisher","key":"e_1_2_7_9_1","DOI":"10.1164\/rccm.201010-1584CI"}],"container-title":["Physiological 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